Question 18

Your child's elementary school teacher comes to see you in clinic for some recent vision changes. Mrs. Evanescence is a 42 year old woman with no significant past medical history. She reports over the past couple of weeks, she has noticed some flashing lights and now has a small paracentral scotoma in the right eye. She has no eye pain, no headache, no recent travel and no febrile illnesses. Vision is 20/40 OD and 20/20 OS. She is not myopic. No RAPD. The external exam is normal. Fundus exam of the right eye shows multiple, round, flat gray to white lesions in the posterior pole that appear deep to the retina. No vitritis. Normal left eye. Fundus autofluorescence shows hyperautofluorescence of the round posterior pole lesions. Fluorescein angiography shows early hyperreflectivity with late staining of the round posterior pole lesions. The most appropriate next step is:

Observation

Doxycycline

Prednisone dose pack

MRI brain

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